An Extremely Premature Newborn with Cutaneous Lesions

An extremely premature 9-day-old female infant in the NICU developed 2 circular lesions on her back. The lesions quickly progressed to a necrotic ulcer. ### Prenatal and Birth Histories ### Presentation At 9 days of age, the infant’s bedside nurse noted 2 small lesions on her lower back; one was 1 cm in diameter, and the other was slightly smaller. The lesions initially had a red raised border with a white center (Fig 1A), but over 24 hours, the centers of the lesions became black (Fig 1B). Figure 1. A. Initial appearance of circular cutaneous lesion on right flank of extremely premature infant. B. Right flank lesion that evolved to central necrosis over a 24-hour period. ### Vital Signs ### Physical Examination (10 days of age)